What is laparoscopy?

About thirty-five years ago, fibre optic technology was introduced. It was found that light could be transmitted along a flexible tube composed of thousands of glass fibres. Fibre optics has revolutionised medical diagnostic options. With fibre optics, it is possible to look into a body cavity with a variety of telescopes with the light source outside the body. Prior to fibre optics, the light would have to be within the body cavity with risks of heat damage to adjacent structures.

For thirty years-five, gynaecologists have been introducing a thin telescope (laparoscope Figure 18.1) into the abdomen to visualise the pelvic organs. Under a general anaesthetic, a small cut is made at the lower edge of the umbilicus (navel). A guarded needle is introduced into the abdominal cavity, which is then filled with about three litres of gas (carbon dioxide). The laparoscope can then be passed through and the gynaecologist can observe the womb, ovaries and Fallopian tubes as well as the surrounding areas. Laparoscopy may be indicated for persistent pain and also at times in the assessment of sudden (acute) pelvic pain. Sometimes minor surgery can be undertaken with the laparoscope (minimally invasive surgeryFigure 18.1).

Diagram of Laparoscopy and Dye Insufflation.

Although we now have a wealth of experience with laparoscopy, the investigation should not be undertaken lightly; as with any operation there can occasionally be complications (surgery risks) with damage to internal structures (about 1 in a thousand). Occasionally the gas is inadvertently introduced into the abdominal wall and the procedure may have to be abandoned or the surgeon may decide that a mini-laparotomy is required.

When laparoscopy was introduced around 1970, research showed that it frequently changed the provisional diagnosis. Since that time new investigation options, such as ultrasound and sensitive pregnancy tests, have increased our ability to evaluate the pelvis and exclude problems such as an ectopic pregnancy. These have decreased the need for laparoscopy.

A 1978 survey of laparoscopy found that 52% of laparoscopies were to investigate pelvic pain. Another study found that 86% of laparoscopies for pelvic pain revealed no abnormality.

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